Complications after 344 damage-control open celiotomies

被引:231
作者
Miller, RS [1 ]
Morris, JA [1 ]
Diaz, JJ [1 ]
Herring, MB [1 ]
May, AK [1 ]
机构
[1] Vanderbilt Univ, Med Ctr, Sect Surg Sci, Div Trauma & Surg Crit Care, Nashville, TN USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2005年 / 59卷 / 06期
关键词
damage control; abdominal compartment syndrome; complications; open abdomen;
D O I
10.1097/01.ta.0000196004.49422.af
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: We reviewed our experience with the open abdomen and hypothesized that the known high wound complication rates were related to the timing and method of wound closure. Methods: All trauma admissions from 1995 through 2002 requiring an open abdomen and temporary abdominal coverage were included. The study group was then classified by three wound closure methods used in survivors: 1) primary (primary fascial closure); 2) temporizing (skin only, spit thickness skin graft and/or absorbable mesh), and 3) prosthetic (fascial repair using nonabsorbable prosthetic mesh). Results: In all, 344 patients required an open abdomen and temporary abdominal coverage either as part of a planned staged damage-control celiotomy (66%) or the development of the abdominal compartment syndrome (33%). Of these, 276 patients survived to wound closure. Sixty-nine of the 276 (25%) suffered wound complications (wound infection, abscess, and/or fistula). Thirty-four (12%) died after wound closure; seven of the deaths as a direct result of the wound complication. Complications increased significantly after 8 days (p < 0.0001) from the initial operative intervention to fascial closure. Primary fascial closure was achieved in 180 of 276 (65%) patients. Although there was no difference in the mean Injury Severity Score between the three groups, the primary group had significantly fewer mean transfusion requirements, shorter mean time to fascial closure, and a lower complication rate as compared with either the temporizing or prosthetic groups. The primary group thus incurred significantly less mean initial hospitalization charges. Conclusion: Morbidity associated with wound complications from the open abdomen remains high (25%). Morbidity is associated with the timing and method of wound closure and transfusion volume, but independent on injury severity. Also, delayed primary fascial closure before 8 days is associated with the best outcomes with the least charges.
引用
收藏
页码:1365 / 1371
页数:7
相关论文
共 38 条
[1]   Has evolution in awareness of guidelines for institution of damage control improved outcome in the management of the posttraumatic open abdomen? [J].
Asensio, JA ;
Petrone, P ;
Rold n, G ;
Kuncir, E ;
Ramicone, E ;
Chan, L .
ARCHIVES OF SURGERY, 2004, 139 (02) :209-214
[2]   Reliable variables in the exsanguinated patient which indicate damage control and predict outcome [J].
Asensio, JA ;
McDuffie, L ;
Petrone, P ;
Roldán, G ;
Forno, W ;
Gambaro, E ;
Salim, A ;
Demetriades, D ;
Murray, J ;
Velmahos, G ;
Shoemaker, W ;
Berne, TV ;
Ramicone, E ;
Chan, L .
AMERICAN JOURNAL OF SURGERY, 2001, 182 (06) :743-751
[3]   Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure [J].
Balogh, Z ;
McKinley, BA ;
Holcomb, JB ;
Miller, CC ;
Cocanour, CS ;
Kozar, RA ;
Valdivia, A ;
Ware, DN ;
Moore, FA .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 54 (05) :848-859
[4]   Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation [J].
Balogh, Z ;
McKinley, BA ;
Cocanour, CS ;
Kozar, RA ;
Holcomb, JB ;
Ware, DN ;
Moore, FA .
AMERICAN JOURNAL OF SURGERY, 2002, 184 (06) :538-543
[5]   Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome [J].
Balogh, Z ;
McKinley, BA ;
Cocanour, CS ;
Kozar, RA ;
Valdivia, A ;
Sailors, RM ;
Moore, FA .
ARCHIVES OF SURGERY, 2003, 138 (06) :637-642
[6]  
Barker DE, 2000, J TRAUMA, V48, P201, DOI 10.1097/00005373-200002000-00001
[7]   Secondary abdominal compartment syndrome is a highly lethal event [J].
Biffl, WL ;
Moore, EE ;
Burch, JM ;
Offner, PJ ;
Franciose, RJ ;
Johnson, JL .
AMERICAN JOURNAL OF SURGERY, 2001, 182 (06) :645-648
[8]  
BUECHTER KJ, 1991, AM SURGEON, V57, P354
[9]   ABBREVIATED LAPAROTOMY AND PLANNED REOPERATION FOR CRITICALLY INJURED PATIENTS [J].
BURCH, JM ;
ORTIZ, VB ;
RICHARDSON, RJ ;
MARTIN, RR ;
MATTOX, KL ;
JORDAN, GL .
ANNALS OF SURGERY, 1992, 215 (05) :476-484
[10]   Abdominal compartment syndrome - The Nashville experience [J].
Eddy, V ;
Nunn, C ;
Morris, JA .
SURGICAL CLINICS OF NORTH AMERICA, 1997, 77 (04) :801-&